The Impact of Centralized Trophoblastic Care on Patients With Gestational Trophoblastic Neoplasia in a Statewide...

Rare cancers such as gestational trophoblastic neoplasia (GTN) should be managed in specialized centers, allowing for multidisciplinary team input, expert pathology review, consensus-based treatment and surveillance pathways, and improved patient survival and patient-reported outcomes.

This retrospective study assessed the impact of centralized care implementation at a tertiary academic women's hospital on patients diagnosed and treated with GTN between 2021 and 2024 in Western Australia. Clinical outcomes compared 2 years pre-centralization (2021-2022) and 2 years post-centralization (2023-2024). The post-centralized patient experience was assessed via surveys.

A total of 36 patients with GTN were included: 20 pre-centralization and 16 post-centralization. Over the 4-year study period, 32 patients were categorized as low-risk, two were high-risk, and two had high-risk histology that precluded prognostic risk assignment. Centralization of care led to an improvement in identifying those who met the diagnostic criteria for GTN (65% vs. 100%, p = 0.011) and subsequent appropriate chemotherapeutic intervention, as well as better accuracy in the assignment of International Federation of Gynecology and Obstetrics (FIGO) stage (41% vs. 89%) and World Health Organization (WHO) prognostic score (46% vs. 82%). Methotrexate was favored as first-line chemotherapy for low-risk disease in both groups. There have been no relapses or deaths in either group to date. Centralization of care led to improved contraceptive counseling documentation (65% vs. 87.5%, p = 0.026) yet similar pregnancy rates. The patient experience with centralized care was positive.

Although study numbers are small, this study supports the establishment of centralized centers for rare trophoblastic diseases.